Title: Barriers to screening pregnant women for substance abuse
Drug and alcohol use in pregnancy poses a threat to the neonate’s development and the obstetric provider has an obligation to screen for substance use. Substance use in pregnancy can place the developing fetus at risk for in-utero opioid dependence, fetal-alcohol syndrome, preterm labor, and other consequences of maternal alcohol, tobacco, and illicit drug use.(6) Within the past three years La Crosse County has seen a marked increase in the amount of heroin use.(7)
The American College of Obstetricians and Gynecologist (ACOG) has clearly documented how instrumental the Obstetrician can be in screening patients for alcohol, tobacco, and illicit drug use. (1,12) The standpoint of ACOG, is that drug screening should be implemented in a non-judgmental fashion which will not deter the woman from seeking prenatal care. (12) In doing so the Obstetrician can facilitate a healthy trustful relationship with their patient in which the patient feels safe to discuss their substance abuse and seek help without fear of litigation.(12)
Many methods of screening have been implemented including neonatal sampling of hair and meconium, maternal urine screening, and maternal self-reports.(11) In considering wide-spread feasibility, self-report measures have been commonly used, some more known and validated methods include the 4 P’s plus and TWEAK. (4,5,13) In the clinic visit, the Obstetrician may also implement a brief motivational interview to assess the patients willingness to change. The Treatment and Intervention Protocol recommends the FRAMES Approach where the providers give feedback, responsibility, advice, menus of change options, empathy, and empowers the patient with self-efficacy for change. (14)
Despite the research supporting screening for substance use, its implementation in clinical practice lags. This study aims to  assess providers knowledge of screening for substance abuse  assess providers beliefs of screening  determine the frequently providers are screening  determine major barriers in discussing substance use with patients  determine if there are adequate substance abuse resources in the La Crosse community accessible to pregnant women.
Participants were selected from Gundersen Health System and Mayo Health in La Crosse. A total of 85 physicians and certified nurse midwives (CNM) were selected. The physicians included Obstetrician, Family Medicine, and Family Medicine Residents. There was a total 23 Obstetrician, 51 Family Medicine, 8 CNMA. *** There were more females in the sample then males based on the prevalence of females providing obstetric care. Age was included w to assess whether there is a difference in practice or attitude towards screening.
Recruitment was done via email initially sent out January 27, 2014 to providers at Gundersen Health and Mayo La Crosse. An additional email was sent weeks later to...